What Are the Latest Studies on Hormone Replacement Therapy Reporting?

What's the latest health trend for women in Sacramento going through menopause? And how does it compare with what women went through back in the 1990s? Sacramento women are wondering what to take for menopause, if anything. A new study has been published this week in an article in The Journal of the American Medical Association. Check out yesterday's NY Times article, October 19, 2010, "Breast Cancer Seen As Riskier With Hormone." The article notes, "Hormone treatment after menopause, already known to increase the risk of breast cancer, also makes it more likely that the cancer will be advanced and deadly, a study finds."

See the article, Hormone therapy increases invasive breast cancer and mortality, WHI 11-year follow up finds
Results of a new Women's Health Initiative report from the University of Buffalo show that hormone therapy is associated with an increased the risk of death from breast cancer, as well as an increased risk of developing invasive breast cancer in postmenopausal women. Also see the Oct. 20, 2010 article, Estrogen replacement therapy speeds ovarian cancer growth, new study reports.

Estrogen therapy used by menopausal women causes a type of ovarian cancer to grow five times faster, according to a new study by researchers at the University of Colorado Cancer Center. The effect of ERT was shown in mouse models of estrogen receptor positive(ER+) ovarian cancer, which accounts for about 60 percent of all human ovarian cancer cases.

Also see, the article, Women fight the effects of chemotherapy long after treatment ends. For some women, the effects of breast cancer, the most common cancer affecting women, do not end when they leave the hospital. Now, researchers in the University of Missouri School of Health Professions have studied the lives of breast cancer patients following chemotherapy and found that their environments and available support systems help determine the quality of their lives.

This same topic of what to take for menopause that would be healthiest in the long-term came up for this Sacramento medical journalist back in 1995. Something felt wrong with taking synthetic hormones back then.

In 1995, this Sacramento author worked as an independent medical journalist and felt unhappy with some of the family's HMO's doctors' responses to questions regarding different treatment methods for the symptoms of menopause. As a medical journalist, this author decided to do informational research to find answers to questions about what the safest road to navigate in menopause happened to be at the time.

The goal emphasized finding information about natural yam-derived progesterone as an alternative to hormone replacement therapy (HRT). And there arose the question of whether even yam topic cremes might overstimulate an already overactive thyroid.

Reading also focused on research that focused on cases in which estrogen in HRT might have been a cause of some of the dangerously high blood pressure mentioned in the case histories of people taking HRT synthetic hormones (who had family histories of hypertension). Using the Internet to access newsgroups and websites, research revealed online information on alternative therapies but also physicians who were able to answer questions about these treatments. Here's the journey on the Internet.

Found also were strategies on how to successfully search for a wide range of health information. Back then, by 1996, only months into the new browser, the Internet did have "picks" for the best websites and newsgroups. You can read my original article on menopause in the article, Second opinion, Internet World 1996 February : 42-44, 46, 48.

What were the alternate sources for menopause and beyond? Through the Internet, you can obtain information your doctor hasn't got time to give you, and talk to people who share your problems.

Doctors don't always have the time or breadth of knowledge to discuss alternative, customized solutions to my family's healthcare needs. That's why I turned to the Internet. After searching the Net for Web sites, support groups, or little-known health newsletters, I found dozens of physicians who offered to give me answers to my specific questions via e-mail.

Each member of my family required a different healthcare service and support group to address their particular problems. In my case, I am allergic to synthetic progestin, which eases the side effects of menopause. At the health-maintenance organization (HMO) to which I am a member, I asked my doctor for natural, yam-derived progesterone. He refused to prescribe it because he said it wasn't yet approved by the FDA, which left me with no alternatives to prevent osteoporosis, for which I'm at high risk. Instead I was put on hormone-replacement therapy, which involves taking oral estrogen. I believed that the oral estrogen was raising my blood pressure sky high. When I mentioned this to my doctor's nurse, she snapped, "Prove it."

So I set off on my journey to prove it. First I checked the alt.support.menopause newsgroup, which was extremely helpful. I posted the following question: Is anyone else using a high soy and vegetarian diet, the herb black cohosh, and natural, yam-derived, progesterone cream for menopause--to help prevent bone loss--instead of the usual estrogen and progestin? If so, what are your comments and experiences?

The replies were practical, useful, and factual, providing medical references, titles of medical journal articles, and book bibliographies, as well as personal experiences and encouragement. For example, one person pointed me to an article entitled "Risks of Estrogens and Progestogens" in the December 1990 issue of Maturitas, an English-language European medical journal. The author, Dr. Marc L'Hermite, found that five to seven percent of women on conjugated equine estrogens could get severe high blood pressure and that they would return to normal when the hormone-replacement therapy was withdrawn. A bibliographic reference to this article also appeared in Dr. Lonnie Barbach's book The Pause. Not one physician at my HMO had mentioned these concerns.

To obtain more information about what alternative health solutions were available and how particular products would change my body or health, I searched the Web under the keywords "menopause," "alternative healthcare," "herbs," "homeopathy," and "naturopathy." I also looked under "natural progesterone."

Through this search I found the MenoTimes, a quarterly journal published in San Rafael, Calif. I subscribed because it had the information I sought on Dr. John Lee's book Natural Progesterone: The Multiple Roles of a Remarkable Hormone.

Also through my search I found a laboratory that would test my saliva and tell me whether my hormones were balanced. Most of all, I wanted to know how taking natural progesterone would affect my fast thyroid and adrenaline-drenched body, with its low blood sugar and excess insulin production. My HMO physicians did not answer these questions, but told me that going off conjugated equine estrogen and synthetic progestin was like a diabetic going off insulin. On the Net I found physicians who answered my letters, labs that sold natural progesterone cream that I could use to prevent bone loss after menopause, and other labs that could monitor my condition until I found a doctor in my community who would listen to alternative solutions to menopausal questions.

I even found the Menopause Matters page created by Susan Czernicka, who said she "learned about herbal treatment of menopause when there were too few resources available to help her with her many symptoms and too few medical providers with open minds." She will answer questions sent to her at susan270@world.std.com.

For those who don't have Web access, there is the Menopause mailing list. To subscribe, send e-mail to listserv@ psuhmc.hmc.psu.edu with subscribe menopaus Your Name in the message body.

The "black cohosh" that I mentioned in my letter to the alt.support.menopause newsgroup is an estrogenic herb and vasodilator, and I wanted to find out how safe it was and whether it was as good for menopause as the homeopaths and naturopaths claimed, as well as how much to use and what effects it would have. I found the alt. folklore.herbs newsgroup helpful, as well as articles by Anthony Brook entitled "Why Herbs?" and "Historic Uses of Herbs" at the Drum Holistic Herbs page.

I wanted to find out everything I could about natural progesterone, so I went to the Health and Science page at Polaris Network, which described itself as "A Guide to Understanding and Controlling PMS, Fertility, Menopause, and Osteoporosis." It contained information about natural progesterone and how it balances the side effects of unopposed estrogen, how it's required for proper thyroid function and progestin counterparts in the drug industry. It also offered a seemingly sound scientific and unbiased evaluation of how certain hormones affect the system, what the hormone's results are on various bodily functions, and side effects. And it had an excellent bibliography of books and medical journal articles on osteoporosis reversal using natural progesterone.

I wanted to query a physician about the high blood pressure resulting from the equine oral estrogen I was taking, and at the Atlanta Reproductive Health Centre page I was able to send e-mail to a doctor who answered my question quickly, providing information that I could consider when making my final decisions or in looking further. His answer was more to the point than the counseling I had received from my own physician.

Another doctor of mine had wanted to give me high blood pressure medicine on top of the estrogen and synthetic progestin. I asked him to consider the alternative--taking me off the hormones to see whether a low-salt diet and exercise could change things--because before I went on hormones my blood pressure wasn't high.

The Internet became one of my best alternative healthcare information resources after the last of three reproductive endocrinologists I saw (not affiliated with my HMO) told me to wait two months to see how I felt off the hormones.

Menopause is a mega-business. More than 100 books a year fill the store shelves on this subject and more than 3,500 babyboomers enter menopause daily. This captivated audience represents a huge market for makers of hormones, vitamins, and other specialty products, much of which is advertised on the Web. So a wealth of information has appeared on the Internet to meet the needs of the 38- to 55-year-olds undergoing menopause, as well as younger women with PMS, infertility, and contraception concerns.

Another resource I found informative was the Women's Health Hot Line newsletter. Its topics include infertility, endometriosis, contraception, sexually transmitted diseases, stress, menopause, and PMS. Most of all, it doesn't close its pages to alternative therapies for women who can't tolerate standard hormone replacement therapy.

Hernia Hunt

This year my husband needed hernia repair surgery, but his busy HMO surgeon spent only a very short time briefing him a month before his surgery. Because it would take hours to describe in detail what is done during hernia repair surgery, he searched on the topic using Web search engines, which yielded a list of information about all kinds of hernias. The most thorough site discovered was the Hernia Information Home Page in England. It included articles that explained such things as the benefits of using mesh rather than stitches to close incisions. Information about hiatal hernias and diaphragmatic hernias could be found at the Collaborative Hypertext of Radiology. There was more information about hernias on the Net than my husband could possibly find time to read.

After seeing shark cartilage in many health food stores, my husband asked his surgeon about its ability to aid in faster wound-healing. The surgeon laughed, yet I found several references to articles discussing shark cartilage on the Internet. Some medical journal articles on the healing and other properties and uses of shark cartilage can be found on the Simone Protective Pharmaceuticals page. Also at the site I found health-style questionnaires, in-depth descriptions of a variety of nutrient products, and how each product affects the body. You'll also find information about where to order or buy shark cartilage from pharmacists.

Search Tips

From the many healthcare sites I visited, my three-ring binder is packed with more than 500 pages of answers to questions. Productive keyword searches can be made using terms such as "alternative health," "healthcare," "medical," "medicine," "nurses," "nutrition," "pharmacy," "physicians," and "smart drugs." I found the search word "healthcare" to be more specific for asking personal medical questions than trying to search under the word "health."

Some sites are best reached through links on dedicated healthcare Web pages. For example, Subhas Roy has a created a page with links to 25 other Internet health sites at Health Info. There also is a large collection of links at the Internet Medical and Mental Health Resources page. It's maintained by Jeanine Wade, Ph.D., a licensed psychologist in Austin, Texas. One particularly comprehensive directory of health and medical sites on the Web is MedWeb, which lists Web sites and mailing lists in 70 categories, from AIDS to toxicology.

One of the best medical referral Web sites I found was Richard C. Bowyer's page. (You'll find it when you scroll past all his genealogy information.) Bowyer's page has links to numerous sites, such as U.S. hospitals, medical resources, medical journals, medical schools, medical students, medicolegal resources, oncology, pathology, and different surgical disciplines, such as plastic surgery, general surgery, laparoscopic surgery, and telesurgery. Healthcare workers of all specializations also can find job opportunities on some of these sites.

My son, who recently became a physician, was interested in Medline, a collection of medical and scientific reports used by physicians, articles on the educational needs of physicians and the public, physicians' supplies, prescriptions, and advice by pharmacists about drugs. Clinical cancer information that is intended for physicians is useful to patients as well. There is a listing of surgeons according to the types of surgery they perform, the notes of the Physician Reliance Network, and a Gopher menu of physicians listed according to their specialty.

As for informative newsletters available on the Net, I highly recommend the University of California at Berkeley Wellness Letter at the Electronic Newsstand. It contains the latest news of preventive medicine and practical advice--including information on nutrition, weight control, self-care, prevention of cancer and heart disease, exercise, and dental care.

As a medical journalist, I found the Journal of the American Medical Association (JAMA) to be a reliable resource. If you are looking for a description of a particular drug, the Physician's GenRx Web site provides a database of drugs you can search. You must register first.

In seeking answers to my health questions, I found the Internet to be a valuable source for a wide range of healthcare information. I'm sure your efforts will be rewarded, too.

Selected Health Sites

Anesthesiology & Surgery Center Offers travel warnings and immunization, medical dictionary.
Cancer Related Links Facts, figures, prevention.
Harvard Medical Gopher Harvard publications, access to the Countway Library's online catalog (HOLLIS), and medicine.
Health Letter on the CDC
Health on the Internet Newsletter Links to NewsPages, CNN Food & Health, MEDwire, describes new health-related Web sites, topic of the month.
HyperDOC Sponsored by the National Library of Medicine.
LifeNet Positive thinking and right-to-life point of views. Discussion about euthanasia.
The Mayo Clinic tour of the Mayo clinic; description of programs.
Med Help International Provides medical information about many illnesses. Treatment is described in layman's terms.
Mednews A biweekly newsletter that welcomes submissions.
Medical Information Resource Center Lists and a referral directory.
Medicine OnLine Career-related educational content and discussion groups.
Medscape For health professionals and consumers. Bulletin boards and a quiz testing your knowledge of surgery. Registration required.
The National Organization of Physicians Who Care Nonprofit organization ensuring quality healthcare. Newsletters, articles about Medicare reform and HMOs.
OncoLink, the University of Pennsylvania Cancer Resource Thorough information about pediatric and adult cancers.
Physicians Guide to the Internet For new physicians.
Robert Wood Johnson Foundation GopherBiological archives at Indiana university, molecular biology database, NYU Medical Gopher.